Pelvic inflammatory disease and infertility

Although pelvic inflammatory disease will not cause obvious complications to the body after it occurs, patients who cannot be cured for a long time will cause infertility. Moreover, there is no way to achieve a radical cure for this disease once it occurs. The disease can only continue to develop on its own. Some patients will even develop fallopian tube cysts.

If pelvic inflammatory disease is not diagnosed or treated promptly and correctly, sequelae of pelvic inflammatory disease (sequelae of PID), formerly known as chronic pelvic inflammatory disease, may occur. The main pathological changes are tissue destruction, extensive adhesion, hyperplasia and scar formation, which lead to: ① fallopian tube obstruction and fallopian tube thickening; ② tubal-ovarian adhesions forming tubal-ovarian masses; ③ if the fimbria of the fallopian tube is closed, serous exudates accumulate to form hydrosalpinx or tubal pyosalpinx or the pus of tubal-ovarian abscess is absorbed and replaced by serous exudates to form hydrosalpinx or tubal-ovarian cysts; ④ the pelvic connective tissue is the main manifestation, the sacral ligaments proliferate and thicken. If the lesion is extensive, the uterus may be fixed.

1. Clinical manifestations

(1) Infertility: Adhesion and blockage of the fallopian tubes can cause infertility. The incidence of infertility after pelvic inflammatory disease is 20% to 30%.

(2) Ectopic pregnancy: The incidence of ectopic pregnancy after pelvic inflammatory disease is 8 to 10 times that of normal women.

(3) Chronic pelvic pain: Adhesions, scars and pelvic congestion caused by inflammation often cause lower abdominal distension, pain and lumbar pain, which often worsens after fatigue, sexual intercourse and before and after menstruation. About 20% of acute pelvic inflammatory disease episodes leave behind chronic pelvic pain. Chronic pelvic pain often occurs 4 to 8 weeks after an acute attack of pelvic inflammatory disease.

(4) Recurrent pelvic inflammatory disease: Due to the destruction of the fallopian tube tissue structure caused by pelvic inflammatory disease, the local defense function is weakened. If the patient is still under the same high-risk factors, it may cause reinfection and lead to recurrent pelvic inflammatory disease. About 25% of people with a history of pelvic inflammatory disease will have another attack.

Gynecological examination: If it is a fallopian tube lesion, a cord-like thickened fallopian tube will be felt on one or both sides of the uterus, and there will be mild tenderness; if it is a hydrosalpinx or a tubo-ovarian cyst, a cystic tumor will be felt on one or both sides of the pelvic cavity, and the movement is often restricted; if it is a pelvic connective tissue lesion, the uterus is often retroverted and retroflexed, with restricted movement or adhesion and fixation, and there is flake-like thickening and tenderness on one or both sides of the uterus, and the uterosacral ligaments are often thickened and hardened, and there is tenderness.